Rexulti , insurance wont cover it

marianHW

hi there, have a prescription for Rexulti for my mom w dementia & Alzheimer’s, however the pharmacy says Humana will not pay for it, & it’s $1,400.00 if I pay out of pocket. Does anybody know a Canadian pharmacy they trust? Thank you M

SDianeL

I would ask Humana why they don’t cover it. The doctor may need to tell them it’s medically necessary for Alzheimer’s agitation Or contact the doctor and ask if there is another drug that is on Humana’s formulary list that is lower cost. It’s an antipsychotic drug for agitation. There are several of them.

SDianeL

Many have been prescribed Seroquel and it helped. Found this online: “If Rexulti (brexpiprazole) isn't covered, talk to your doctor about alternatives like other antipsychotics such as aripiprazole (Abilify), cariprazine (Vraylar), or quetiapine (Seroquel), or consider antidepressants like sertraline (Zoloft) or duloxetine (Cymbalta). You can also ask your doctor about a generic version of Rexulti, which may be more affordable, or explore non-medication options like therapy.”

marianHW

Thank you for your help! Humana would not talk to me, they wanted to talk to my mom, they said I have to email them POA and then wait five business days for them to get back to me and let me know why they won’t cover it. As if this role being a caretaker isn’t hard enough, every day there are new challenges and roadblocks .

harshedbuzz

@marianHW

Rexulti is just a newer atypical antipsychotic that went through the process of obtaining an approved indication for agitation in dementia. It carries the same risks and Black Box Warning as the older ones; it's not that special. The makers of other atypical antipsychotics like Seroquel, Risperdal, etc. have not done this as it is an expensive exercise for a medication which is available as a generic.

I would not get into it with Humana over this unless you have trialed the other options and had bad results. Call the prescriber, explain the situation and ask for a different drug from the same class. My dad did really well on a generic for Seroquel, fwiw.

HB

PS It's a good idea to proactively send a copy of the POA to be vetted by her banks, Humana and anyone else you may need to work with going forward. The process can take a couple weeks, so it's best to do it ahead of time.

KrisSky16

My Mom was just prescribed Rexulti but was luckily approved for a grant. Her Neurologist said if she did not get approved for Rexulti that Seroquel was just as good and much cheaper. Good luck with everything.